Some specific cases of D3 toxicity. (They are hard to find)

More recent cases of Vitamin D overdose: from: > look here <

Several cases of vitamin D toxicity have just recently been reported in the literature, demonstrating the sort of very large daily amounts that may lead to ill health. All were due to some sort of error.

In the first case, a pharmacist’s dispensing error occurred when a physician prescribed 1,000 IU/day of D3. Since it was not a prescription item, the pharmacist assumed the doctor meant Rx Drisdol, which is 50,000 IU D2. So the patient, a 70-year old woman with mild dementia, began taking 50,000 IU/day of D2. She was also taking, for unknown reasons, 3,100 mg of calcium per day [Jacobsen et al. 2011].

After 3 months of this regimen, the woman developed signs of hypercalcemia: confusion, slurred speech, unstable gait, and increased fatigue. She was hospitalized for hypercalcemia and acute kidney injury secondary to hypervitaminosis D; her 25(OH)D level was 194 ng/mL. All vitamin D supplementation was discontinued and 5 months after discharge, the patient's serum calcium and vitamin D concentrations, as well as renal function, had returned to baseline values.

The second case involved an otherwise healthy man who developed fatigue, excessive thirst, frequent urination, and confusion after taking a commercial vitamin D supplement for 2 months. Three weeks after becoming symptomatic he was admitted to the hospital in a coma with a vitamin D level of 1,220 ng/mL, calcium of 15, elevated urine calcium/creatinine ratio, and mild anemia. He had been taking a supplement (“Formula F”) labeled to contain 1,600 IU of vitamin D but which actually contained 186,400 IU per capsule due to manufacturing error. Additionally, the product label recommended 10 capsules per day, so the patient had been taking 1,864,000 IU daily for two months. After treatment, calcium returned to normal in 3 weeks; the vitamin D level and the creatinine returned to normal in a year [Araki et al. 2011].

In the third case, reported in the Araki et al. paper above, a 40-year-old man developed excessive thirst, frequent urination, muscle aches, nausea, vomiting, elevated calcium, elevated creatinine and Ca/Cr ratio, mild anemia, and a 25(OH)D level of 645 ng/mL. He reported taking a supplement for a month (“ Gary Null’s Ultimate Power Meal”), which mistakenly contained 970,000 IU of vitamin D per serving. Following treatment, calcium returned to normal in several days, kidney function returned to normal in 4 weeks, and vitamin D level normalized in 10 months.

It is noteworthy that in these cases — involving extremely large amounts of vitamin D taken for an extended time — there were no deaths or permanent injuries, once proper treatment was provided. While the human body appears to have greater tolerance for excessive vitamin D supplementation than many believe, it is still advised that caution be exercised when prescribing any vitamin D supplement or in selecting a good quality over-the-counter product. Additionally, some have recommended that persons taking more than 10,000 IU/day of vitamin D should have their 25(OH)D levels checked regularly, and that the level should be maintained below 100 ng/mL [Vitamin D Council here].
REFERENCE:
> Araki T, Holick MF, Alfonso BD, et al. Vitamin D Intoxication with Severe Hypercalcemia due to Manufacturing and Labeling Errors of Two Dietary Supplements Made in the United States. J Clin Endocrinol Metab. 2011(Sep 14); online ahead of print [abstract here].
> Jacobsen RB, Hronek BW, Schmidt GA, Schilling ML Hypervitaminosis D Associated with a Vitamin D Dispensing Error (October). Ann Pharmacother. 2011(Sep 13); online ahead of print [ abstract here].
> Skversky AL, Kumar J, Abramowitz MK, et al. Association of Glucocorticoid Use and Low 25-Hydroxyvitamin D Levels: Results from the National Health and Nutrition Examination Survey (NHANES): 2001–2006. JCEM. 2011(Sep 28); online ahead of print [ abstract here].


Acknowledgment: Thanks to John Cannell, MD, of the Vitamin D Council, for providing some of the details regarding the above case examples.